Challenges That ICD-10 Brings to Physicians

Prior to ICD-10 there will be an educational component, so physicians will have to revisit their coding knowledge and get up to speed on ICD-10.

 

This is an exponential change, so that educational component will be significant not only for the billers and coders but also for the physicians. That would be the first change relative to ICD-10.

 

The second change is that here will certainly be a different set of tools that physicians will use to help them map to the more specific and complex codes that are related to ICD-10.

 

Another change is that they need to make sure that they are aware on a daily basis of the results of their coding regarding reimbursements. Today there may not be the strong connection between the ICD-9 codes and the billing reimbursements in the physician’s mind.

 

Going forward, because of the increased specificity around ICD-10, there is the increased chance that improper coding is going to negatively affect reimbursements even more so than today because of that increased specificity. Physicians are really going to need to be on top of how they code and oversee the medical coding operation in a more hands on way regardless of whether that’s outsourced or done in-house.

 

Physicians are going to have to be much more engaged than they have been historically in the coding process.

 

ICD-10 is certainly going to present an array of challenges for physician offices and providers throughout the healthcare industry. It pretty much breaks down into 3 areas and challenges for providers.

 

1. Preparedness. Do they have a plan in place that’s going to allow them to handle the major changes that are associated with ICD-10? Have they done the workflow analyses? Have they mapped what their processes are today?

 

2. Education. This represents a significant change for physicians as well as all of the coders and billers on their staff.

 

3. Tools. What are the technologies and pieces of information that they are going to need to properly use the ICD-10 code sets?

 

The larger organizations in the healthcare industry have already booked significant dollars in projects under way to begin to prepare for ICD-10. For physician practices specifically, it’s probably the right time to do the analysis, as they’ve completed their 5010 conversions for the January deadline in 2012. It’s probably the right time for them to start to work towards understanding their current processes, doing the gap analysis, and understanding what the code set changes are going to do to the way they practice medicine and the way they run their offices.

 

It’s probably just about the right time for billers and coders and physicians to start to explore what their education opportunities are, and it’s probably a little early to choose technology solutions because many vendors are still developing what those code support tools are going to be as relates to ICD-10.

 

If practices aren’t up to speed by the time ICD-10 starts in October 2013, it’s quite frankly equal to something of an operational suicide. There is no option to be noncompliant. The very core of the clinical, operational, and financial side of a physician practice hinges on the ability to properly code and, therefore, get reimbursed by payers — both commercial and from the government. There really is no option to be noncompliant that doesn’t have a fairly disastrous outcome come October 2013.

 

As far as tips for practices as ICD-10 approaches, I think the first thing is to realize that you can’t start to be prepared too soon. Take a look at your operations today, the clinical coding, the workflows of both the billing team and the coding team, as well as physicians themselves. How do they enter codes? Getting prepared for that and understanding what is going to change is probably the first step. The second is to have an education plan in place as quickly as possible.

 

This is an exponential change that is going to take a while for billers and coders and physicians themselves to understand, and this is not going to be a "learn it in a weekend" sort of scenario. This is going to be a steady re-education process between now and the deadline. I would encourage practices to get both the preparedness and the education plan in place as quickly as possible.

 

The third piece I would urge people to understand is to tighten the relationship between the different parts of the organization. Understand the impact of coding as it relates today, but certainly as it becomes closer to ICD-10. Understanding the relationship between coding decisions and reimbursement realities is going to be very important.

Last, I would urge people to look around and understand what the tools and technologies are that are going to help them make the transition as smoothly as possible. I wouldn’t say that as we get closer that that’s when we start to use those tools, but as we are today I would encourage folks to just see what’s out there and understand what would be most helpful as it relates to their workflows.